Sore throats

  1. 0 I feel really dumb asking this (especially since this is my 3rd year as a school nurse) but what exactly are we supposed to look for with a sore throat? I don't send anyone home or even call home unless they are in tears. They get a salt water gargle and I tell them to hang in there. I look at their throats, but I assume that a slightly red throat is to be expected. I also assume it's "normal" for their cervical lymph nodes and tonsils to be swollen since they're sick. What kind of symptoms would make you send them home, besides a fever? I've looked up symptoms of strep throat, but I don't feel confident that I know what I'm looking for.
  2. Visit  tictac profile page

    About tictac

    Joined Jun '06; Posts: 83; Likes: 60.

    10 Comments so far...

  3. Visit  Kafergie profile page
    1
    I only send home for a fever. I may let a parent know if the throat just looks terrible (spots, patches, etc) but leave it up to them in regards to a pick-up. I will mention though, that we have had a run of kids with strep without fever, so fever may no longer be the tell-tale sign
    NutmeggeRN likes this.
  4. Visit  NutmeggeRN profile page
    0
    You can look at the size of the tonsils, look for any striation or pus pockets.

    I looked in a girls throat one day and she went straight to the ENT and had a pocket lanced! She was FULL of crud!If you have an iPad there is a great app called.


    DrawMD Pediatrics it allows you see what a common picture of mono is and what strep looks like. Does it look like everyone? No, but one of the neat feature is you can email the illustration to the MD/PCP and show them jut what you are seeing. Sometimes it is SPOT ON!

    There are also other body systems in the program as well and I am pretty sure it was free!
  5. Visit  Flare profile page
    0
    i'm usually looking for a beefy red throat, presence of any pus, and swollen, tender glands combined with elevated temp. All those things are my red flags.
  6. Visit  tictac profile page
    1
    Thanks for all the tips! I guess what makes me doubt myself is that I can honestly say I've never seen a "beefy" red throat or even pus, but SURELY I've had kids that exhibited those symptoms. I just want to see one clear cut case of strep or mono and say A-HA!

    On another note, I did have a little girl my first year who came in complaining of pain on one side of her neck and nothing else. My guess what that she had a crick (sp?) in her neck from sleeping on it weird. Even her mom agreed that's probably what it was. Fast forward one week, and I see the little girl, who says she was hospitalized because of strep throat that night and "had an IV and everything". I felt so bad! I did confirm with the mom that she was indeed hospitalized. I've never poo-poo'd neck pain since then.
    NutmeggeRN likes this.
  7. Visit  NutmeggeRN profile page
    2
    Hind sight is 20/20!
    100kids and Tina, RN like this.
  8. Visit  Wave Watcher profile page
    1
    I look for rash (kinda like sand paper), nausea, vomiting, sore joints/swelling in joint = Strep Throat
    Also, petechia on the roof of the mouth also goes along with strep.
    multi10 likes this.
  9. Visit  Esme12 profile page
    2
    Quote from tictac
    Thanks for all the tips! I guess what makes me doubt myself is that I can honestly say I've never seen a "beefy" red throat or even pus, but SURELY I've had kids that exhibited those symptoms. I just want to see one clear cut case of strep or mono and say A-HA!

    On another note, I did have a little girl my first year who came in complaining of pain on one side of her neck and nothing else. My guess what that she had a crick (sp?) in her neck from sleeping on it weird. Even her mom agreed that's probably what it was. Fast forward one week, and I see the little girl, who says she was hospitalized because of strep throat that night and "had an IV and everything". I felt so bad! I did confirm with the mom that she was indeed hospitalized. I've never poo-poo'd neck pain since then.
    Kids with strep can also complain of mid abdominal pain......there are some pretty good pictures of strep on Google.
    NutmeggeRN and multi10 like this.
  10. Visit  multi10 profile page
    3
    The nose knows. Strep smells.
  11. Visit  brillohead profile page
    0
    When you know what a "normal" throat looks like, it's usually pretty easy to tell when something is majorly off.

    My son is a sleep-mouth-breather with seasonal allergies, so he often complains of a sore throat in the morning and I tell him to drink something and give it a half an hour -- usually once he starts breathing through his nose and has rehydrated the tissues, the soreness resolves. One Saturday morning he told me his throat hurt and I gave him my usual advice. He spent the rest of the day eating/drinking normally, playing with friends, playing video games, etc. -- no more mention of pain.

    That evening, twelve hours later, he asked if he could spend the night with a neighborhood friend. I asked him if his throat still hurt, and he said, "yeah". So I grabbed a flashlight and had him open up for a look and OMG! There was every color of the rainbow living on his tonsils, with clumps and goop and all kinds of nasty going on in there.

    And since nobody in my family ever gets sick M-F/9-5, we had to go off to the ER for abx on a Saturday night. I *hate* using the ER for PCP things, but our town doesn't have an Urgent Care Clinic, and there was no way in heck I was going to wait 36+ hours with that kind of toxic ooze living in my son's head!

    Anyway, long story short, when there's something major going on, chances are pretty good that you're going to see that things aren't status quo. And some things just aren't obvious on kids -- that same son, when he was 3yo, ended up with pneumonia that the pediatrician initially diagnosed as bronchiolitis. It happens.
  12. Visit  NrsAng profile page
    0
    I look for tonsil edema and how close to the uvula the tonsils are. I have to agree with an above posters about the absence of fever. Recently, I have had many students with confirmed strep that were afebrile.


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